World Health & Population
From the Editor-in-Chief: Themes in World Health
Osagbemi et al. offer an extension to primary prevention efforts for HIV/AIDS through an intervention to change a traditional cultural practice. In "Culture and HIV/AIDS in Africa: Promoting reproductive health in light of spouse-sharing practice among the Okun people" the authors report on testing an intervention with a pre-post control group design. The intervention resulted in increased knowledge of transmission patterns for the disease, and higher "intention to discontinue spouse-sharing" in the intervention communities. Whether this approach can actually decrease spouse sharing (with the goal of decreasing HIV transmission), remains for follow-up research.
The third article that touches on the HIV/AIDS epidemic in sub-Saharan Africa does so through the very difficult subject of sexual violence in refugee populations. In "The relationship of sexual and gender-based violence (SGBV) to sexual-risk behaviour among refugee women in sub-Saharan Africa," Johannes John-Langba reports on interviews with 402 refugee women from 16 different countries in a camp in Botswana. A remarkable 75% of the women interviewed reported being victims of SGBV. Not surprisingly, a number of negative health impacts were noted. More importantly, however, an increase in sexual risk behaviors (putting the women at higher risk of HIV/AIDS) was causally associated with previous SGBV.
Reproductive health care issues are address by Amitha Kalaichandran and David Zakus in "The obstetric pathology of poverty: Maternal mortality in Kep Province, Cambodia" and by Halder et al. in "Inequalities in reproductive healthcare utilization: Evidence from the 2004 Bangladesh Demographic and Health Survey." Kalaichandran and Zakus link underreporting of maternal mortality with the Millennium Development Goals, identifying through verbal autopsies maternal mortality rates potentially two times higher other in-country estimates in Cambodia. The interesting turn-of-phrase "obstetric pathology of poverty" (attributed to Abdel-Aleem in 1993) gets to the point that, even in resource constrained countries, it is the very poorest that continue to suffer the greatest disadvantage in reproductive outcomes. The article by Halder et al., based upon the Bangladesh Demographic and Health Survey, points out that along the continuum of antenatal, delivery, and postnatal services, postnatal services are typically the most neglected, and that reproductive health care needs to be both physically and financially accessible, as well as appropriately targeted for the population being served.
The two articles focusing on primary care do so from very different angles. The first, "Geographic targeting of risk zones for childhood stunting and related health outcomes in Burkina Faso" by Florence Margai points out that appropriate targeting of services in highly resourced constrained countries is a complex challenge. Margai uses sophisticated geo-mapping techniques to identify at-risk populations for childhood stunting, but concludes that "broader, more integrative approaches are needed" both to identify the at risk populations as well as the appropriate multifaceted intervention. The second article relating to primary care, "A pilot study to evaluate malaria control strategies in Ogun State, Nigeria" by Adeneye et al., is a descriptive study of awareness of treatment initiatives and policy changes related to malaria control. Linked with efforts around the 2010 Roll Back Malaria targets, the cross-sectional household and clinic surveys reported by Adeneye et al. conclude that better use of multiple modes of communication are necessary, as well as a better understanding of how the target population receives, processes, and acts upon information related to malaria control.
Finally, there are two articles in this issue of WHP which move to problems of middle income countries and issues perhaps more familiar to health policymakers in OECD countries. "Performance of universal health insurance: Lessons from South Korea" by Sangho Moon and Jaeun Shin briefly describes the remarkable 12 year transition to universal health insurance in that country (from 1977 to 1989), and benchmarks the progress of South Korea across the dimensions of access, cost, and outcomes since that time. It is certainly a remarkable accomplishment. The last article, "Living Arrangements and the Role of Caregivers among the Elderly in Latin America," by Antonio Trujillo, Thomas Mroz, and Gustavo Angeles, analyses a cross-sectional, population-representative data set ("SABE"), similar to the Health and Retirement Survey in the U.S. The authors take a labor economics approach in examining the role of caregivers for the elderly in four Latin American countries, the exchange of services for care giving (e.g., childcare) in these settings, and possible conflicts arising from the increasing participation of women in the workforce. Since the proportion of elderly in the population is increasing more rapidly in Latin America than other areas of the world, significant policy challenges must also be faced in the future.
We hope that you find these articles of interest and value, and will additionally explore the other offering online at www.worldhealthandpopulation.com. The editors and publishers of WHP are always interested in any comments or suggestions you might have on the articles or journal. Please feel free to write or e-mail us.
About the Author(s)
John E. Paul, PhD
Editor-in-Chief, World Health and Population
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